Posted
by
kdawson
on Tuesday December 01, 2009 @03:28AM
from the always-jam-tomorrow dept.

Lucas123 writes "Researchers at Harvard Medical School pored over survey data from more than 4,000 'wired' hospitals and determined that computerization of those facilities not only didn't save them a dime, but the technology didn't improve administrative efficiency either. The study also showed most of the IT systems were aimed at improving efficiency for hospital management — not doctors, nurses, and medical technicians. 'For 45 years or so, people have been claiming computers are going to save vast amounts of money and that the payoff was just around the corner. So the first thing we need to do is stop claiming things there's no evidence for. It's based on vaporware and [hasn't been] shown to exist or shown to be true,' said Dr. David Himmelstein, the study's lead author."

Your records belong to you. You can request them (and depending on the hospital / doctor's office, they may claim you can only receive copies or that they will only send them directly to your new healthcare provider) at any time and take them with you.

Wow, in the hospital where I work, the doctors frequently turn up to the IT department saying how they've just bought in a new system and they need it supported. If they get told 'no', they complain to the directorate that IT aren't supporting a system based on IT. The directorate lean on IT (with not so veiled threats) until IT support a system they'd have vetoed if they'd be involved in procurement..

The problem that has been evaluated is that the research was done on an organisation with no true enterprise architecture (at the business silo stage at best). In other words, somewhere that hasn't invested in IT (and likely has the doctors doing what they feel like, with 'homegrown' Access databases and applications, trusting what the vendors say when they produce shiny pamphlets, and either not hiring people who understand how business and tech should map, or not giving them the clout to be able to change the way the organisation works to successfully be able to change things so that they do).

I do IT for a major regional hospital chain, and all this time, I thought it was just my company that was this fucked up.

What you're talking about is EXACTLY what happens. Doctors, managers, vendors, whoever CONSTANTLY show up with junk hardware and software, throw it at us, and expect us to support it. The organization is so bloated around the middle that no one has the authority to tell anyone else no. We have hundreds of Access databases, SQL servers running on people's desktops, and

I'd believe it. But whether it's doctors getting conned by vendors, or administrators (or IT) making decisions without the inputs of doctors the result is the same - useless and troublesome IT systems.

Himmelstein said that only a handful of hospitals and clinics realized even modest savings and increased efficiency -- and those hospitals custom-built their systems after computer system architects conducted months of research.

He pointed to Brigham and Women's Hospital in Boston, Latter Day Saints Hospital in Salt Lake City and Regenstrief Institute in Indianapolis as facilities with some success in deploying efficient e-health systems. That's because they were intuitive and aimed at clinicians, not administrators.

Programmers of the successful systems told Himmelstein that they didn't write manuals or offer training. "If you need a manual, then the system doesn't work. If you need training, the system doesn't work," he said.

In other words, computers are not a magic bullet. They only work well when you actually invest the time to find out what you need them to do, and then make them do that.

I think as well as any savings or efficiency increases, they should also take into account the relative ease with which electronic records can be backed up and restored in case of fire or flooding, etc. At the very least, there should be scans of any paper documents. Full hardcopy backups would take up a lot of space, and they're not very easy to replicate if you do end up losing the originals.

Nope. The current Electronic Medical Record systems are not capable of exchanging information freely. There is no standard data format that everyone can exchange.There are a few standards that can package data, but they are not adequately specified for seamless interoperability.If you request records, they can print them out quickly for you though.

A good point. I have been working on a committe developing standards for the transmission of information between veterinary records in the UK (and we have interest from other countries). The so-called VetXML standard is already being used for insurance claims and lab results, with referrals on advanced testing.

As per/. standards, I did not RTFA, but I would suggest that "Poorly designed computer systems do not save money" would be a better title.

There are clear benefits of the new system so I am confident to say that not only is it more efficient and will save money compared to a manual system, but it will also do the same compared to our other two clinic management packages - one is old and reliable (accessed through VT220 terminals or PCs running an emulation package) but very outdated and has no serious reporting or connectivity abilities, the other is 'modern' but buggy (crashes often), poorly written with a bad database schema that is totally space inefficient.

I encounter situations like this a LOT... There will be an old system which is perfectly reliable, has been running for years and everyone can access it using whatever ancient terminals they have at their disposal. And it will usually be quite efficiently written because it runs on old hardware.Then some vendor will come along and blind management with a pretty graphical frontend, so they sign up and begin a transition to a new fancy looking graphical system which looked very pretty to the management types who quickly demoed it at the vendors offices...

Of course, the vendors setup will have a very small data set, will be carefully set up to look as good as it can (they might not even let you touch it, just demo it themselves being very careful to avoid features which are known to be buggy), and the management types won't have tested it for very long (or at all) before they decided to buy, and these same management types won't have to use the resulting system once it's installed.

Costs will rapidly escalate as you have to replace all your ancient terminals with new fancy equipment designed to handle the pretty graphics...You start loading your live data into the new system and find that when it has actual data in it, the new system is very slow and inefficient (but still looks nice!) because it was never tested under any realistic usage cases...You find that the original quoted hardware requirement was already insufficient (to make it look cheaper), and coupled with how slow the new system runs with real data you now have to increase your hardware budget...

And once the system is finally installed and people start using it, you find that...While the app looks very pretty to management types, the people who actually have to use it find that the pretty graphics get in the way, and that the new app is far less usable than the old one.Your users were used to the old system, and don't like the new one, but this gets dismissed as "users dont like change" and blamed on them wether that's the case or not.Even new users who weren't used to the old system have trouble with the new one..When under actual load, the performance issues are even worse..The new system has lots of bugs, which the vendor expects you to adjust your working practice around rather than bothering to fix them...The new system also has a different workflow, which again the vendor expects you to adjust your working practice around.The new system brings with it a lot of unnecessary functionality which you don't need, and which will get abused by staff and external hackers alike (people didn't spend all day using facebook on green screen terminals, and didn't browse websites or view files which try to exploit your machine and own it)..As a result of the unnecessary functionality and new security risks, your administrative burden is now much higher (or the vendor convinces you otherwise, and you coast along for a while before you start having major problems).

There's even more to be said for well-written software. What your post boils down to is, "poorly written software will not work as advertised." You're not going to get much argument on that here. The problem with the article (and your conclusion) is that they implicitly assume that all computer-based solutions are equal in quality. Since that isn't true, the analysis is ignoring a crucial component.

While this may be true, my mom (a retired nurse) laughed her ass off when some politician came on TV talking about the savings there would be in having the medical field completely computerized. She said the FIRST THING a doctor does when they take over your case is print every. damned. single. bit. of your info out and stick it in the chart and while they are caring for you they scribble on the things all kinds of orders, notes, etc which then some poor nurse has to come along and put BACK into the compute

One would wish. Doctors either spend more time with electronic systems than with paper systems... or if it is a good system... about the same time.The current systems haven't made doctors more productive. There may be an exception or two though in select settings where considerable grant dollars were poured in to build a locally optimized system.Building good clinical systems is hard.

"The problem "is mainly that computer systems are built for the accountants and managers and not built to help doctors, nurses and patients," the report's lead author, Dr. David Himmelstein, said in an interview with Computerworld."

The systems aren't put in help the doctors. They are put in by the non-medical managers to help their jobs. And they fail at that. A system designed for doctors with the goal of reducing error and improving care could work. But that's not what the systems are. They should start working now to have all records be electronic, X-rays, MRIs, personal history, etc. should be in formats that can be directly shared between doctors. Then processes and systems that are designed to help the medical care should be used to put that information to good use and let patience get improved care for a lower cost. But the systems are all billing systems first, and care second. And that's why they fail, and always will. Improving billing doesn't help care, and can often make it worse, as having a doctor or nurse putting in billing codes will only slow down the process.

That's only part of the story. A LOT of systems are put in by heads of medical departments who engage directly with vendors, who tell them this system will cure all their ills and make the world a better place.They then buy in this system without asking anybody, and turn up at IT saying "We've bought this, put it in now please". Most hospital directorates back the clinicians (politics, gotta love it) and force IT to support this, even though it may duplicate information held elsewhere, or not be able to communicate with anything else. This crucifies efforts to create an enterprise class architecture.That being said, there are (in the NHS) many moves towards having everything standardised and digital (PACS, for example, works nicely; Dicom imagery across all hospitals connected to the NHS network. That's your XRay and MRI imagery right there).

The problem is that very few places take IT seriously. It's viewed as a "wave a magic wand and things happen" discipline. Few want to hire system admins, let alone systems architects.And without people to actually work at integrating IT to the business, and without them having the remit to be able to affect business processes to help this symbiotic relationship take hold, then places will continue to scrabble ineffectually.If you're building a house, hire an architect. If you're building an IT system to prop up your business correctly, hire a systems architect.You could, of course, be happy with your IT system being the logical equivalent of a house built on mud with 22 windows on one side of it (never facing the sun) and no stairs to the upper floor that can be used.. But hey. You choose the path you walk.

The problem with the IT industry is that it does not solve problems for users. Programmers for the most part have very little domain knowledge, and it shows. About 5 years ago I saw the trend of shifting from general knowledge to specific and shifted to the investment banking industry.

You might oh you f***d up big time. Ha, on the contrary. I actually got in at the right time. They are now looking for people who can write code and trade. Not an easy combination, but somet

"The problem "is mainly that computer systems are built for the accountants and managers and not built to help doctors, nurses and patients," the report's lead author, Dr. David Himmelstein, said in an interview with Computerworld."

That's not the problem, and doctors aren't going to make money-saving decisions anyway (what planet is this guy from). The real problem is that hospital administrators are uninformed and powerless. For example, most hospitals use Group Purchasing Organizations (GPOs) that actua

As a personal anecdote, computerized medical records most likely saved my father's life.

He woke up in the middle of the night with unbearable pain in his abdomen, and when he didn't fight my mom about going to the hospital she knew it was serious. Five hours later and untold scans and prodding later (not to mention a significant amount of morphine) they determined a blood vessel leading to my father's colon had been blocked and basically part of his colon was dead or dying. Not having the facilities or expertise to handle the necessary surgery in my mid-size town of Owensboro, KY, they sent him to the University of Louisville Medical center telling us that basically, even done by the best surgeons in the business there is a 3 out of 4 chance he wouldnt' make it through surgery unless it was done in the next few hours. The trip to Louisville takes two hours. Following the ambulance we arrived in Louisville in an hour and a half, and he was in his room and being prepped when the doctors realized they didn't have any scans of his abdomen, the EMTs had left them behind in their rush to get us all there. Faxing them was the only option, and to do that they would have to get in touch with someone in Owensboro, convince them who they were, have them look up the records, and then get them to a fax machine that could handle the scans. It could take another hour.

Except my mother (who, frankly, is the smartest person I know) insisted that she be given a copy of the CD with all the electronic scans and data the doctors had collected that morning. I thought the surgeon was going to kiss her. 20 minutes later my father is in surgery, and 5 hours after that (or so, it was a long day) he was back out and kept in ICU for two weeks before finally coming home. The doctor had said if he'd had to wait much longer chances would have shot up considerably that my father would have died.
So, there is at least one example of how Electronic Medical Records did help a doctor save a life.

Cool story bro, though that probably wasn't an EMR: just some DICOM images. Of course I can't say that with full certainty, just with what I know from working IT in a hospital. But it's still cool that it helped save his life.

But, those records weren't available to be sent over when required. Your mom did it. If she hadn't, regardless if they were paper or electronic, they would have gotten there too late.

That's a change that has to happen. I'm starting to build my own patient file on myself. Every time there's a test, or anything more interesting than "I have a cold, gimme some antibiotics", I get my own copy of their records. Unfortunately, I didn't start doing this years ago. I've tried to

I worked on an EHR procurement process for the last several years and, yes, there's a LOT of crapware out there, but I have seen systems deployed that were almost entirely reliant on the input of the actual front-line providers and they'd sooner saw off their own arms than go back to paper records.

"They should start working now to have all records be electronic, X-rays, MRIs, personal history, etc. should be in formats that can be directly shared between doctors."

The systems aren't put in help the doctors. (...). But that's not what the systems are. They should start working now to have all records be electronic, X-rays, MRIs, personal history, etc. should be in formats that can be directly shared between doctors.

I'm going to argue just a bit. My wife just went through breast cancer this summer. The records, MRIs and actions that took place -were- electronic, and at more than one point -were- used to facilitate actions between a group of physicians that were part o

Seriously - when are you slashdotters going to realize that part of the reason that nobody takes you seriously is because your analysis is so junior high level?

I have a masters in business. When the people making the business decisions are divorced from the operations of the business, the item that helps them most may not help the company at all. Having seen the results of such decisions, I assure you the consequences are quite real, and because of poor managerial decisions.

Wow, I so just NEVER post anonymously but... I work at a healthcare company. Specifically, a Healthcare IT company. A very big one. One which develops an elctronic medical record, amongst other things, and is joined at the hip by several hospitals (we are a non-profit, they founded us)...

Think about the flaws in how the government works, and you can start to grasp the problem. These institutions are setup, not to make a profit, but to do a job. To that end, they are going to do that job... come hell or high water. Its noble, its great, its a bureaucratic wet dream. They even budget the same way. In fact, last year is the FIRST TIME IN MY CAREER that when the end of the fiscal year rolled around, we did NOT hear talk of needing to use up the rest of our budget before we lose it.

The problem is, that they create a whole bunch of fiefdoms, give them a mission, and then let them just creep that mission over the years. New servers, new disaster recovery plans. More security.

Then we interact with government, and everyone has a stake in healthcare so...more regulations? Ever heard of hippa? No? Then you don't work in healthcare. We have yearly ethics classes, a whole department whose job is to police ethics internally. Increasing regulations seem to push us forward a lot.

We are a mini-government. In many ways, I like it. How many other workplaces have an appeals process on disciplinary that can go all the way to an employee review board of randomly selected employees from other departments? We essentially have a jury system built into the company!

And while governments have a feedback loop through voting, we do too. We have the board, which is chaired by big wig stakeholders, many of whom are hospital administrators and power player doctors. They allocate our budgets, they push agendas... which feed through us, and back to the hospitals, and their management.... which is our feedback loop.

Its a labyrinth of departments, groups, teams, on down the line. An undulating stack of bureaucrats each moving forward, increasing his scope. Every department knows money is being wasted. However, its the other guy wasting it, because we are on a mission. We have to deliver this service right here, no matter what it costs.

I wish I had time for more but, my group has a mission. Maybe later I can wax poetic about how "middle heavy" institutions like this grow. Remember those articles on the Gervais principal and how it relates to "The Office". Google it and reread it... realize that these organizations work under those dynamics, but remove the "organization falls apart" feedback loop. Imagine that model running its course for the 150 years that some hospitals have been around.

Of course, theres been corruption too. We grumble about not even being able to take pens or free classes from vendors anymore. A whole host of new policies, all because a couple of guys were scamming contracts. These policies will never go away... only grow. (something which I have seen at 2 of the places that I have worked. In one they were fresh policies from a scandal that happened while I was there, and one from a scandal 20 years prior)

THAT is where the problem is. This constant slow creep of policies, regulations, departments.

We are over ambitious. The more code we write, the more bugs we create.

The trouble with hospital data is that it is messy. You have to accept that.

It's tempting to design a hospital data system with specific fields for each item, every procedure enumerated, and every field validated. You want to normalize your data. You want it neat and tidy. You can work very hard trying to enforce this. You're screwed though, because life isn't like that.

You'd be better off with relatively "dumb" software, almost like a wiki, that lets you efficiently handle arbitrary text and arbitrary data blobs. It needs fast Google-style search. It needs to allow arbitrary associations so you can handle stuff like a patient claiming to have the same social security number as a different patient or a patient who claims to have a different identity than he did the last time he visited.

Then you need to keep medical staff away from both paper and computers. Data entry is for data entry specialists.

Perhaps he meant unnecessary paperwork, not all paper... but even so, hospitals DO have transcriptionists. The doctor picks up a phone, dials a couple numbers (or uses a bar code reader or something, given the right equipment) and starts reading off their diagnosis. Then a transcriptionist somewhere else (perhaps around the world) gets that recording and types out what the doctor said into the phone. Ideally, the doctor gets that document back and approves it, though that part rarely happens. Then it's

Are extremely change adverse as well. I worked at a large cancer centre. After a software upgrade that added a lot of extremely helpful features I still got tonnes of complaints for things like "the close dialog button moved from the bottom left of the form to the bottom right". Sure you have muscle memory, but it is an extremely minor difference and you still know what you need to do, but still it was a big deal for them. It was sometimes to the point where doctors just didn't want to deal with any change

I would like to see him try to do0 the mapping of a genome with paper and pencil.

Yes, that would be as unbelievable as designing the Eiffel tower without a computer.The number of pieces in the Eiffel tower is in the same order of magnitude as the number of human genes (the bolts can be compared to base pairs). Clearly not doable.

The old saying that "when all you have is a hammer, every problem starts looking like a nail" is true for computers too. We think of a computer solution first without even considering how something can be done other ways.

Exactly. The huge savings from computers come from the fact that totally new procedures can be made. It is slower for most people to use a tablet PC or a laptop than a paper notebook, the savings are not made there and if it is the only part that is changed, you'll loose money by doing so.

* Use open standards (so that old and new equipement can easily communicate, and so that different departments can share information)
* Network everything that is not life-critical.
* Define clear access rights enforced

And have significant responsibilities for patient care and management. Computers have made my life much easier. With electronic charting I can follow all of my patients directly from a terminal that I carry with me. The charting software we have includes basic spreadsheet and summary functions that are highly customizable. I am able to track trends and make decisions for my patients based on sight and intuition rather than having to sort through paper charts and bad handwriting. Its all at my fingertips. I don't know where Dr. harvard did his research but maybe he just has bad software. My computer system is outstanding and I honestly don't know if I'll ever be able to work in another hospital.

yes - but you missed the bit about efficiency. "Computers have made my life much easier." is usually how we express efficiency.

Over a decade ago I did a stint at a hospital looking after the pathology database. When it was down and paper records were required then lives were at risk due to the lack of efficiency (time spent accessing paper). It honestly scared me!

I'm sure things are much much more reliant on computers now. Computers are not just for the hospital admins.

"Lives were at risk due to the lack of efficiency"?What part of "money" did you not understand?

See... the good Doctor Himmelstein would like to run a hospital (whose job is to save lives and provide the unquantifiable product such as health) as a slaughterhouse.Bodies come in - work is done on them - bodies come out and you get money. Simple and straightforward.

Aaah... but hospitals can't be run as a profit-based business - cause they are not. Hospitals provide "service" needed to run the society.Yo

The diagnosis was clear: the WHC emergency department had a severe case of "datapenia," or low data counts. (Feied invented this word as well, stealing the suffix from "leucopenia," or low white-blood-cell counts.) Doctors were spending about 60 percent of their time on "information management," and only 15 percent on direct patient care. This was a sickening ratio. "Emergency medicine is a specialty defined not by an organ of the body or by an age group but by time," says Mark Smith. "It's about what you do in the first sixty minutes."

Smith and Feied discovered more than three hundred data sources in the hospital that didn't talk to one another, including a mainframe system, handwritten notes, scanned images, lab results, streaming video from cardiac angiograms, and an infection-control tracking system that lived on one person's computer on an Excel spreadsheet. "And if she went on vacation, God help you if you're trying to track a TB outbreak," says Feied.

To give the ER doctors and nurses what they really needed, a computer system had to be built from the ground up. It had to be encyclopedic (one missing piece of key data would defeat the purpose); it had to be muscular (a single MRI, for instance, ate up a massive amount of data capacity); and it had to be flexible (a system that couldn't incorporate any data from any department in any hospital in the past, present, or future was useless).

It also had to be really, really fast. Not only because slowness kills in an ER but because, as Feied had learned from the scientific literature, a person using a computer experiences "cognitive drift" if more than one second elapses between clicking the mouse and seeing new data on the screen. If ten seconds pass, the person's mind is somewhere else entirely. That's how medical errors are made.

END QUOTEI agree wholeheatedly with the last bit : I can't count how many times I've been to a doctors office or library or other institution and had to wait for a person to pull up my information on "the system". If you're gonna build a friggin computer system to handle local records, for the love of God don't scrimp on the hardware! Optimize the software! It should be INSTANTANEOUSLY fast!

...But it has to look pretty, or the folks with access to the bank account will never buy it! It also needs animated sliding panels, customizable positions for all controls, and must fit the graphical style of Windows 7, so the office staff don't get confused. When the programmers are done with those important goals, then they can work on the petty stuff like speed and usability.

Let's not forget, it also absolutely MUST interface with the mainframe they kept records on in the 80's, just in case they need th

But it has to look pretty, or the folks with access to the bank account will never buy it! It also needs animated sliding panels, customizable positions for all controls, and must fit the graphical style of Windows, so the office staff don't get confused. When the programmers are done with those important goals, then they can work on the petty stuff like speed and usability.

I work in a hospital as an interpreter, so I see a lot of how people use computers... and how they don't. Generally in the ER, the patient first sees the triage nurse, who asks a series of questions. The answers all get entered into the computer. Then the patient sees their actual nurse, who asks many of the same questions again. This information may or may not get entered in the computer. Then the PA comes in and asks the same questions a third time. This time, the information gets written on a piece of paper, or maybe a tablet computer. Eventually, the attending physician stops in just long enough to ask the same questions a fourth time, and doesn't enter the info anywhere. If the patient is admitted and sent to another department, the process starts over.

I made a call to HP (abbreviated to protect the company:) recently to have a failed disk replaced under warranty. I went to great lengths to explain that I was a consultant acting on behalf of the customer, gave HP all of my details and all of the customers details etc. I could hear constant typing in the background so something was being entered somewhere. About 20 minutes later I got a call from my office saying they had HP on the line asking who the onsite contact was, who the customer was, and where the part should be sent.

It's not just hospitals... I think I can generalise the conclusion of the article - if the solution (IT or otherwise) isn't designed/built right, and people don't know how to use it right, then it isn't going to work right and is going to make peoples lives harder not eaiser. Seems kind of obvious when you put it that way though.

Could you explain why this is a bad thing? The way you describe it, there
are four people who each independently verify the information,
instead of what? One person who enters some data into the computer and three
people who read it back?

If each person has a 25% misdiagnostic rate, then four independent people
asking questions gives a combined misdiagnostic rate of less than 1%.
If three people trust the diagnosis of the first person, then the combined rate
is 25%. Regardless of the actual numbers involve

That's an interesting comment and it made me think. Initially my thought was that that the system you describe sounds silly and wasteful (I'm an IT-focussed guy and I hate the thought of information being captured multiple times and rekeyed).

But then I thought - perhaps it's actually quicker for those doctors to simply ask the question again, rather than to find a workstation and query the patient record. Perhaps by asking the question themselves they garner additional information from the way that the pati

The boundless creativity of politicians and bureaucrats to develop new and more complex regulation is bounded only by the bureaucracy's inability to implement them. The absolute size of the bureaucracy is constrained by external factors, so the only effect of automation can be to increase bureaucratic complexity.

Parkinson's laws are as valid and insightful as always. If someone by chance have missed them, here they are:

Parkinson's First Law:
Work expands or contracts in order to fill the time available.

For some large government projects, it gets to the point that it would be cheaper to simply hire 10 different companies to all produce the software product that you wanted, and then simply pick the best one.

Bingo. You have just pointed out why capitalism beats socialism. Nine private companies fail, one emerges as the industry leader.

Bingo. You have just pointed out why capitalism beats socialism. Nine private companies fail, one emerges as the industry leader.

Then the industry leader becomes so large it steamrolls competition while at the same time producing flabby, uninspired software. This bloated behemoth will persist long past when it should have mercifully died in its sleep and it takes ages for incompetence to erode that market lead, to allow competitors back into the marketplace. And when you think it might finally take in that final breath, the capitalists running the thing will successfully lobby the government for a bailout, not even blinking as they s

That some of this has to do with the staff being largely of the 35+ crowd and the propensity of that crowd to not know how to use computers even remotely as well as, say, a 16 year old kid does right now.

Computers take more work to use when you don't have a nice grasp on not only the software or function you're doing, but the regular logical deductions you make from repeated observation and experience.

From my experience in life, most older people have somehow adapted themselves to 'get by' with technology,

Having worked in an academic medical center and having a bit of exposure to doctors, I can say this...they may be able to patch you up but most doctors don't know shit about computers. It's the reason that most of them still scribble things down in some incomprehensible handwriting--they either don't have the time or don't want to learn a different system for keeping records.

Actual savings probably won't be realized until everyone in the system starts to use it and have information that is easily transf

> That some of this has to do with the staff being largely of the 35+ crowd and the propensity of that crowd to not know how to use computers even remotely as well as, say, a 16 year old kid does right now.

That used to be a favorite argument to explain away poor clinical system adoption. But it does not hold true anymore. An average doctor today is at least as computer savvy as an average teenager. They may not use SMS, twitter or use facebook as much as the teens, but they certainly know how a computer works. This isn't the 90s when computers were optional in life.

> Computers take more work to use when you don't have a nice grasp on not only the software or function you're doing, but the regular logical deductions you make from repeated observation and experience.

Good clinical software should not need you to be an expert in computers... just that software... the one they use for several hours each day. And if it takes considerable experience to get up to speed... that's a usability problem... not a user problem.

That some of this has to do with the staff being largely of the 35+ crowd and the propensity of that crowd to not know how to use computers even remotely as well as, say, a 16 year old kid does right now.

This is exactly what I witness. I am working as a Software developer in a University Hospital in Europe. Just an example:

It often happens here, That some one enters data into a system. Then another devision needs said data and guess what they do? Data is printed out, faxed internally to another devision and usually a subset of the data is entered manually into another system again. Despite the fact that all involved users have access to both systems and if they'd use the systems appropriate, data would be e

........ In my view, some big issues are (1) the problem is actually harder than it seems , given the extreme flexibility needed, (2) this is not understood by the designers, leading to horrible usability & functionality issues and (3) the good software engineers seem to go to other fields. There are lots others, but I agree this is a very solvable problem. I often wonder what would happen if we had a game design team on the job.

Your right when computer systems get this complex you need good project management , systems analysis and design.

(Just did a semester of this subject.)

You need to build the system from scratch and the people doing it need to work out what processes are needed and what are not and they need to talk the users of the system then (the poor people) have do it all over again till the system works.

Almost everyone who's ever used a line of business app could have told you this. Good LOB apps will ask the question "how can we use PC to make the experience more efficient?". Bad ones will just say "paper sucks, lets make it digital!" have the exact same fields a paper would have, but make you type it. The bad ones might be marginally easier for management because of their rudimentary search and reporting, but are usually no different or even worse for the actual day to day users.

Yet management is continually suckered into thinking less paper == more efficient, and there are _a lot_ of bad LOB apps out there because of it.

Seriously having a centralized database won't save time tracking down something vs a massive filing "complex" in the basement? I'm sorry but that is just bullshit no matter what the study says. Thats like saying I would be better off with a folder full of images as opposed to Picasa and iPhoto to help manage. Perhaps the time spent would similar if I were a retard or a caveman unfamiliar with a PC. But I assumed people in the medical profession had some semblance of intelligence. At worst a computer should be no less effective, and hey it lets you sit on your fat lazy ass too!

Yes, but you must young if you have never encountered the problem of lost paperwork. Anybody older than 50 is likely to have had this happen at least a handfull of times. Digital covers this problem (if done right), which I'm pretty sure was a major element of the pitch in the first place. Efficiency doesn't mean shit when the info is already lost.

Computers in hospitals have never been about saving money. Of course they cost more than writing stuff down on paper and shoving it in a folder.

Computers are about 'patient safety' and are a tool to help elminate errors. Test results came back from the lab? Computer system gives messages/popup reminders to actually CALL the patient and let them know the results are in. Non computer system, a piece of paper comes back saying you have cancer and the nurse files it and thinks "I'll call when I get back

I am working in a large Hospital as software engineer. I can tell you, that it's more safe to give a nurse a piece of paper than a computer. why? because the nurse's primary goal is to treat the patient and to to use this scary computer thing!

It might be about safety (i don't answer you the answer) but -- as I see it -- it is about having alot of data (especially history and current results) at your fingertips (from the perspective of a doctor). This safes time and enables them to see the bigger picture in

TFS: For 45 years or so, people have been claiming computers are going to save vast amounts of money

Reminds my of ancient times (yes, about 45 years ago) when my father was sitting over nicely striped printouts (blue and white) at home in the (late) evenings, swearing about the introduction of (then) a mainframe for bookkeeping. He was not convinced that the thing would save either work nor money and never changed his opinion.

From what I've seen of the corporate world, these decisions are made by two groups of competing bullshit artists who've worked their way up to command decisions. One is trying to sell you a product that may or may not do what you need and the other is trying to low ball you *regardless* of what the sticker price is. Management needs to either promote more techies to these levels or put them in places where they can make *real* feedback on the process.

Its funny because I have to go to the local public hospital regularly for my broken arm. Renovations are under way and the Fracture Clinic has acquired a nice new office since I started going there. The new office has attracted a manager who divides his time between chatting up the receptionist (he must be desperate) and standing outside empty consulting rooms saying c'mon, a patient could be in here.

Maybe I'm misinformed, but don't most (private) U.S. hospitals treat doctors like customers? In several computer systems that I saw in New York state, they were providing different report styles and different input methods (from e-mail to hand-written) for the different doctors. The reason I was given was that they had to do this, since doctors who didn't feel the hospital system suited their unique requirements would suggest different hospitals to their patients. The resulting computer systems were very

Computerized health care systems are not designed for the benefit of hospitals. They are designed for the benefit of entrepreneurs.

Health care is a multi-bazillion dollar industry where information is managed via bearskins and stone knives. Development of an integrated computerized health care system will net the intelligent investor more money than even Microsoft can dream about.

This is the message that people I will call "serial entrepreneurs" pitch. Their intent is not to build such a system (that would be nigh on impossible given the absolute chaos of incompatible processes that currently exist in hospitals). They simply want to build a system that looks close enough that stupid investors will throw millions of dollars at it. The potential payoff is so big (seemingly) that people will keep throwing money at it even after said entrepreneurs have razed and burned a stack of companies.

Of course, eventually there *will* be a company that succeeds (mostly by accident). That company will run suspiciously like SAP where there will be a very complex set of computer programs designed to support an even more complex set of processes. These processes in turn will have nothing to do with the underlying business of providing health care. However senior management will be ecstatic that they finally have a unifying computer based process, and the only people who fully realize its true futility will be the people doing the work. They, of course, will be ignored.

Large hospital invests in an extremely expensive computerized charting system.

Staff were not paid to chart after their shift concluded. Instead, despite being overworked, they were expected to chart as they went through the day.

Said charting system had a key combination called "Magic Lookup", whereby pressing two keys for a given patient data field inserted the value put there from a previous charting input (i.e. temperature, blood pressure, ambulated, etc., etc., etc.). Wh

Most IT is about dumbing down. It lets you shed highly trained, expensive staff who are hard to recruit by replacing them with some electronic "brains" and a pair of minimum-wage hands to carry out the machine's orders. For most organisations the key driver is not cost (no matter what they tell you), it's risk. Risk that people will fail, risk that someone else will get to market before them, risk that their tame geek will walk away and take all their I.P. with them, risk that they aren't seen to be using "

Palo Alto medical foundation implemented online system to allow any doctor or patient to access patient's records and exchange e-mails. If you see a specialist and then go to a primary care physician for annual exam, he/she immediately sees what happened to you and what tests need to be done. Many routine matters like prescription renewals or questions about OTC drugs can be handled without revisiting the clinic. How is that not saving money or even health/lives?

I'm a radiologist and computers have definitely improved patient care and saved the hospital money (or alternatively made the hospital more money) in our field. From digitized images and the ability to outsource to overnight coverage to voice recognition to get turnaround for finalized reports in an hour it has undoubtedly worked. And that's with in most cases only fair implementation of a computer system.

With most hospitals, the problem is that they like to do a piecemeal transition. Digitize a subset of notes and vital signs, half the time what you need isn't there so you have to look through the paper chart AND the computer chart. Or the vital signs are only half in the computer and half on a chart, so nurses double their workload. And when it's set up, they do it with an IT-centric interface that doesn't make intuitive sense to most users. When I use them I can see through my background in computer science and engineering why things are done a certain way, but it doesn't make any sense to physicians, nurses, etc.

Then they add in a new piece, such as more vital signs (but in a different section), some dictated notes, some linking to the outside. Outpatient notes are digitized, inpatient notes are still handwritten, etc. ED notes are separate, with their own system. It's a complete mess. This method is a waste of money and time, all for the sake of early deployment of a suboptimal system and minimal re-training of the staff to use a new system.

The VA had a decent attempt with CPRS. They digitized everything - from physician admission notes to clergy notes. At least everything is in one place, but people are overwhelmed with data and it's too easy to copy and paste incorrect or inaccurate information. The interface is also suboptimal (graphing lab values involves selecting a range of tests, building a worksheet, etc. much like you'd expect an engineer to make it for maximum flexibility, but minimal ease of use). And connecting to other VA systems is hit or miss.

Perhaps the best method is to build a new hospital from the ground up. All patient records get digitized (scanned, at least, if not run through some OCR). Have a tightly integrated medical record system developed in collaboration with health care practitioners. That would save the hospital money, in the long run, compared to them starting from scratch with paper records.

I get my X-Rays in DICOM format from my public hospital. I convert them to PNG and post them on my blog [glitch.tl]. I must have a DICOM library loaded because gimp will read those files on ubuntu but it refuses to load some of the files, in particular the more recent ones.

Do you have any suggestions for reading DICOM which don't involve running windows and using the DLLs on the CD from the hospital? Thanks.

I recently showed up at the ER late at night, with a broken wrist.
The ER doctor looked at the X-rays, then called the fracture specialist at home, who looked at the X-rays on his home computer,
and passed on his advice to the ER doctor.

Honestly if you want to increase the average health care, which means the health care for most people and only pay 50% of what you pay now, just change your health care system to any system in West Europe (except the British one). Even the German one is better and that still sucks. BTW computer can be a helpful tool to manage data, but that is often not the real problem. In most cases it is bad management, induced by the wrong goals.

For a while in the UK, the government has been spending billions of pounds on NHS IT systems. There is enormous potential to improve the situation, but so far it just hasn't been used. The prime example is electronic medical notes as mentioned in the article.

Currently, I live and work 22 miles apart. I'm only allowed to use the doctor near my home, even though they are only open during working hours. The reason for this is my medical notes - f I need an emergency home visit (I never have) they will need

The trouble with that is that you're then forcing them to be assessed on the metric you're assessing on them or inadvertently game the system (intentionally or not). I can think of plenty ways to make hospitals more "efficient" if you can compromise patient care...

How to say if computers save money to a hospital? Do you take into account reduction in errors, perhaps malpractice errors that could cost millions? Do you take into account expanded possibilities? If you now have a service that wouldn't be possible without computers, are the profits of that service included in the study?

I once made a program for a manufacturing company, that sequenced the production in the different machines. They had at the time one person making the sequence for the machines manually. Th

When "computerizing" medical facilities, the argument is not about how much cheaper treatment is going to be, but how much better it will be for the patients.
So, computers are "bad", right?
How about scanners, computerized microscopes, computer assisted operation tools and/or any other monitoring system?
Sure, they cost more than if they were not used/purchased, but aren't all these meant for BETTER healthcare, and not cost reduction ???

Computers installed and maintained in a competent fashion, running software which is appropriate to the job at hand and being used by staff who are proficient with that software can save money, potentially a lot of it...

On the other hand, many IT projects are terribly mismanaged, poorly budgeted, installed by cheap unqualified staff, running unsuitable software which expects people to adapt to its way of doing things rather than the other way round, and used by staff who are unsure how to use the system correctly and are often too fearful to touch it unless forced to..Ask the average joe on the street, and they will tell you that computers are extremely unreliable black boxes, they have no idea how they work and are very fearful of touching them incase they break, especially at work where they're likely to face disciplinary action for breaking the computers.

In a lot of cases, computers are simply not appropriate, and in many more cases computers in the form that get installed are completely unsuitable for the task and are actually inferior to what they replaced.

You also have the attitude of third party suppliers and corrupt people high up in the client organizations where the situation changes from "what do we need" to "how can we justify purchasing something from "... IT is one of the worst affected industries for this, because people generally have less understanding and are therefore easier to fool.

The goals of these people is not to save money, it's not their money to save, it's someone else's money that they are in charge of, and their primary goal is to siphon as much of it out and into their own pockets as possible.

I developed products in this space for a number of years. One big problem we always encountered was the in-house proprietary systems. Time and again we would hear "we'll buy your system as long as it can interface with this shiny, homegrown monstrosity that we developed". Of course the person most responsible for the purchasing decision (at least from the technical end) was also usually the manager who was responsible for creating (or at least maintaining) the inhouse monstrosity. To throw it out is to admit a giant mistake, to potentially cut staff (and hence reduce power) and so instead they try to make vendors jump through hoops. Our natural response was to wrap our products with integration services, which breeds a support nightmare (no two customers have the same thing) and is also very labor intensive, and hence expensive, making it very hard to justify for the projected "savings".
As an example, I once spent a year (mostly on my own time each night at home) logging in remotely to a hospital system, running migration scripts to move image data from an inhouse system into our system. Each morning I would tell the customer's technician to load a new batch of disks, then I would kick off the migration each night. And mind you, this is ONE customer at ONE hospital. And of course first I had to write the migration scripts... another sunk cost.

When I broke my arm there was a long wait for X-Ray because their system had a virus. Later I got my X-Rays on CD and it came with convenient DLL files to help load the data. If I ran windows I would have been a bit worried about that.

I wanna know the specs for a computerized hospital wide system, service interruptions (hardware failure,...)? My life is not just in the hands of a doctor, a 7 year or so trained medical professional, but a misanthropic programmer that drinks to much coffee. All i am saying there are cons to a computer system as well.

Having worked in medical records with a paper based system your life is also in the hands of the clerk who handles your records.

You just gotta hope that the clerk can find your chart that one of the nurses or a specialist as locked in there office when your sitting in emergency wondering why the doctor has not seen you yet. "Can not see the patient without there chart".